Sunday, April 19, 2009

As Kenyans mark one year since the swearing-in of the grand coalition cabinet, it is almost unanimously agreed that the government has failed in all the key performance measures it set through the four agenda items listed in the National Accord.

Despite attempts by those in government to put on a brave face and pretend that all was well, their disagreements dramatically emerged when talks meant to evaluate the coalition’s performance on key indicators collapsed over the agenda.

One of the most important social indicators of a government’s performance is the health of its populace.

During election campaigns, many of the pledges made included improvements in the health sector, with some promising free or subsidised health care, while others promised better terms and conditions of service for health workers.

Health docket

When the Cabinet was announced this time last year, many were eager to find out who would hold the important Health docket and what sort of ideological bent the ministry would take. Instead, we were rewarded with two Health ministries, one in charge of medical services and the other in charge of public health.

How the determination was made that medical services and public health are distinct, separable entities was left to the imagination of Kenyans.

As a result of the split of the ministry of Health, there has been a duplication of bureaucracy and expenditure without any discernible improvement in service delivery. What we are treated to are daily squabbles over which ministry is in charge of what activity or funds.

Indeed, in many offices in the ministry of Health one will today find two heads, one representing the ministry of Medical Services and the other representing the Public Health ministry.

This is the situation prevailing at the National Aids/STD Control Programme (NASCOP) and at the provincial level there are two senior medical officers generally duplicating each others’ roles in service delivery.

The two ministers have taken to communicating through the media, as though they do not get to meet during Cabinet meetings. Last week they engaged in theatrics over the registration of a body to regulate nutritionists and dieticians, with one minister using the head of nutrition services and the other using the deputy to run parallel bodies.

Meanwhile, the cost of health care continues to climb, and many are now seeking health services only when they are very severely ill. Services offered at most government health facilities remain quite basic.

Money that should have been used to improve services is instead being used to maintain a parallel bureaucracy whose net effect is just to enrich individuals and massage the elephantine egos of ministers and their sidekicks.

Indeed, the government appears to be so flush with cash that it is even considering building a “state-of-the-art” referral hospital in Karen!

Why they do not use the money to improve Kenyatta National Hospital and Moi Teaching and Referral Hospital as well as the provincial hospitals defeats logic.

As another big hospital is built in Nairobi, many provincial and large district hospitals are still grappling with staff shortages and lack of equipment and supplies. Key facilities at these large hospitals with huge catchment areas have been built and are maintained by NGOs and other donors.

Service delivery has suffered due to this ambiguity and lack of clear policy direction. The ministry of Health was in the process of implementing a strategic plan, and the split threw a spanner into the works by stalling the process and blurring the lines of responsibility for all those involved.

Indeed, there are many functionaries at Afya House who are no longer sure who their political boss is, and others have multiple supervisors spanning the two ministries.

The time has come for Kenyans to get serious in demanding accountability and good governance from those they elect to serve them. We must stop making excuses for the two main members of the coalition.

Whenever things appear to stall, they often come out blaming their coalition partners for the failure, forgetting that by agreeing to serve in the same Cabinet they also agreed to share responsibility.

Sharing responsibility should not only be done during the good times such as when they are appointing CEOs of parastatals and heads of government departments. The partners must be ready to share responsibility even when they fail.

Kenyans must hold them collectively responsible for the problems they face every day when they seek health services in government facilities and come away disappointed.

It is hoped that as they scramble to replace the minister for Justice, National Cohesion and Constitutional Affairs, the “principals” will be persuaded to re-unite the ministry of Health under one political head in order to truly improve service delivery.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer, Moi University’s School of Medicine